OP0278-HPR THE RELATIONSHIP BETWEEN HEALTH LITERACY AND TREATMENT STATUS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS WHO ACHIEVED LUPUS LOW DISEASE ACTIVITY STATE: THE TRUMP2-SLE PROJECT
Authors: K. E. Sada, Y. Miyawaki, K. Shidahara, S. Nawachi, Y. Katayama, Y. Asano, K. Hayashi, E. Katsuyama, T. Katsuyama, M. Narazaki, Y. Matsumoto, N. Oguro, Y. Ishikawa, N. Sakurai, C. Hidekawa, R. Yoshimi, D. Kishida, T. Ichikawa, Y. Shimojima, N. Kurita, N. Yajima, Shunichi Fukuhara
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Although the relationship between health literacy and treatment outcome has been reported in certain illnesses[1,2], it remains unclear how health literacy affects treatment selection. <h3>Objectives</h3> This study aims to determine the relationship between health literacy and treatment status in patients with systemic lupus erythematosus (SLE) who have achieved a low disease activity state (LLDAS). <h3>Methods</h3> A cross-sectional study was conducted on 266 SLE patients who had achieved LLDAS, registered in the TRUMP[2]-SLE study[3], an ongoing multicenter cohort study conducted at five academic centers in Japan. The main exposure was the health literacy (scores 0-56) of the enrolled patients, as measured by the 14-item Communicative Critical Health Literacy Scale (FCCHL). The primary outcomes were daily glucocorticoid dose, hydroxychloroquine (HCQ) use, and immunosuppressant use. A secondary outcome was chronic damage measured by Systemic Lupus International Collaborating Clinics-Damage Index (SLICC-DI). Odds ratios (ORs) to assess the relationship between health literacy and treatment status were estimated with adjustment for confounders (age, sex, income, education, disease duration, and SLICC-DI). <h3>Results</h3> The median age of the patients was 47 years (interquartile range [IQR], 36-58), 88% were female, and the median disease duration was 13 years (IQR, 7-20). The median FCCHL score were 3.1 (IQR, 3.0-3.5). The median daily glucocorticoid dose (prednisolone equivalent) was 4 mg (IQR 2-5). HCQ was used in 122 (45.9%) and immunosuppressant was used in 174 (65.4%) of enrolled patients, respectively. FCCHL score were not associated with glucocorticoid dose (r<sup>2</sup> = 0.015). FCCHL score was not statistically different between patients with and without immunosuppressants (median 3.07 [IQR, 2.79-3.36] and 3.04 [IQR, 2.71-3.29], p = 0.81) but statistically different between patients with and without HCQ (median 3.14 [IQR, 2.36-3.93] and 3.00 [IQR, 2.71-3.25], p = 0.0028). After adjustment for confounders, HCQ use was significantly associated with FCCHL score (OR: 2.27, 95% confidence interval: 1.19-4.36). FCCHL score was not statistically associated with SLICC-DI (r<sup>2</sup> = 0.0091). <h3>Conclusion</h3> Even among the SLE patients who have achieved LLDAS, the preference of HCQ usage may vary depending on health literacy. <h3>References</h3> [1]Lauren KT et al. Limited health literacy is associated with worse patient-reported outcomes in inflammatory bowel disease. Inflamm Bowel Dis. 2019;25(1):204-212. [2]Federman AD, et al. Asthma outcomes are poor among older adults with low health literacy. J Asthma. 2014;51(2):162-7. [3]Noriaki K et al. Trust in the attending rheumatologist, health-related hope, and medication adherence among Japanese systemic lupus erythematosus patients. Rheumatology (Oxford) 2022 Oct 3;keac565. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> KEN-EI SADA Speakers bureau: Speaker's fee from Glaxo Smith Kline K.K., Grant/research support from: Research grant from Pfizer Inc., Yoshia Miyawaki: None declared, Kenta Shidahara: None declared, Shoichi Nawachi: None declared, Yu Katayama: None declared, Yosuke ASANO: None declared, Keigo Hayashi: None declared, Eri Katsuyama: None declared, Takayuki Katsuyama: None declared, Mariko Narazaki: None declared, Yoshinori Matsumoto: None declared, Nao Oguro: None declared, Yuichi Ishikawa: None declared, Natsuki Sakurai: None declared, Chiharu Hidekawa: None declared, Ryusuke Yoshimi: None declared, Dai Kishida: None declared, Takanori Ichikawa: None declared, Yasuhiro Shimojima: None declared, Noriaki Kurita: None declared, Nobuyuki Yajima: None declared.